Exclusion:Eligible professionals who have lessthan 100 transitions of care and referrals inthe reporting period do not have to meetthese measures

Note:For any of these measures it isimportant to remember that the recipientdoes NOT also have to have Certified EHRTechnology.

3

Feature Focus:

ToC

Measure #2 & 170.314(b)(2)

•The eligible provider, eligible hospital orCAH that transitions or refers theirpatient to another setting of care orprovider of care provides a summary ofcare record for more than 10% of suchtransitions and referrals either:

•(a) electronically transmitted using

CEHRT to a recipient; or

•(b) where the recipient receives thesummary of care record via exchangefacilitated by an organization that is aNwHIN Exchange participant or in amanner that is consistent with thegovernance mechanism ONC establishesfor the nationwide health informationnetwork.

–Number of transitions of care and referrals during the EHR reportingperiod for which the EP or eligible hospital’s or CAH’s inpatient oremergency department (POS 21 or 23) was the transferring orreferring provider.

•Numerator:

–The number of transitions of care and referrals in the denominatorwhere a summary of care record was a) electronically transmittedusing CEHRT to a recipient or b) where the recipient receives thesummary of care record via exchange facilitated by an organizationthat is aNwHIN

Exchange participant or in a manner that is consistentwith the governance mechanism ONC establishes for the nationwidehealth information network. The organization can be a third-party orthe sender’s own organization.

5

Certification Options

6

Option 2

1.EHR sends “data” to HISP

2.HISP generates

CCDA

3.HISP performs as STA andsends Directmsg

HISP/HIE certified

on itsown.

Option 3

1.EHR generates

CCDA

2.EHR sends CCDA to HISP

3.HISP performs as STA andsends Directmsg

HISP/HIE certified as“relied upon software”with the EHR.Certification given to thepair, not separately toEHR and HISP.

•The fact there’s a “HISP/HIE in the middle” is irrelevant with respect to Provider A meeting MUrequirements. Provider A’s use of their CEHRT’s optional transport capability enables ProviderA to include this transmission in Measure #2’s numerator (consistent with the measure’srequirements and that Provider B receives the summary care record).

•Under this approach,HISPs/HIE entities do not have to be certified.Thisallows any EHRvendor supporting the SOAP + XDR/XDM option to interoperate with any HISP that alsooffers SOAP + XDR/XDMsupport.

Exchange participantin the middle is irrelevant with respect to Provider A meeting MU requirements.

•AneHealth

Exchange participant does not have to be certified, however, Provider A muststill use their CEHRT’s capability to generate a standard summary care record inaccordance with the CCDA and Provider B still needs to receive the summary care record inorder for it to count in Provider A’s numerator.

•Similar to Example 2 under Approach 1B, the fact that there is an entityin middle is irrelevant with respect to providers #1-4 meeting MUrequirements. However, there are two scenarios to keep in mind whenit comes to having EHR technology that meets the Certified EHRTechnology definition and how that could affect MU measurement.

•Scenario 1:If provider’s #1-4 have CEHRT without the aid of an HIEand use the CEHRT’s transport capability (Direct or SOAP) to send aCCDA formatted summary care record to an HIE entity whichsubsequently enables the summary care record they’ve sent to bepulled by another provider, then a pull of that summary care record justneeds to occur by provider #5.

•Scenario 2: In contrast to scenario 1, if provider’s #1-4 depend on theHIE entity to satisfy the CEHRT definition (from either a paired or standalone certification approach) and thus rely on it to create the CCDAformatted summary care record and transmit it to provider 5 as a resultof a pull, these providers would need to have EHR technology that hadbeen certified in a stand alone way or combination with the HIE toperform the full requirements specified in the certification criterion (asdescribed per prior slides).

•In either scenario, for all providers where the patient meets thedenominator requirements for measure #2, when provider #5 pulls thepatient’s summary care record from the HIE entity, they can then countthat pull in their numerator as a transmission to provider #5.

HIE entity

12

Let’s Recap

•Three certification options are available forToC

certification

1: “Native” capabilities all within the same EHR technology solution

2: EHR technology + HIE/HISP combination

3: HIE/HISP stand alone

•EHR technology developers that include and seek testing andcertification for the optional SOAP + XDR/XDM can provide a “HISP/HIEagnostic” solution for their customers.

•There are three approaches to demonstrating MU:

1A:Use CEHRT’s “Direct” capability

1B:Use CEHRT’s “SOAP+XDR/XDM” capability

2:Use CEHRT to create a CCDA and partner with aneHealth

Exchange participant

3:Use CEHRT to create a CCDA that is then retrieved/queried by another provider

•For any of these MU approaches transmissions will only count in the measure’snumerator if they are received by the provider to whom the sending provider isreferring or transferring the patient.